Table Of ContentPlanning Parenthood
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Planning Parenthood
Strategies for Success in Fertility Assistance,
Adoption, and Surrogacy
Rebecca A. Clark, M.D., Ph.D.
Gloria Richard-Davis, M.D., FACOG
Jill Hayes, Ph.D.
Michelle Murphy,J.D.
Katherine Pucheu Theall, Ph.D.
the johns hopkins university press
baltimore
Note to the reader: This book is not intended to provide medical or legal advice. The
services of a competent professional should be obtained whenever medical, legal, or
other specific advice is needed.
© 2009 The Johns Hopkins University Press
All rights reserved. Published 2009
Printed in the United States of America on acid-free paper
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Library of Congress Cataloging-in-Publication Data
Planning parenthood : strategies for success in fertility assistance, adoption,
and surrogacy / Rebecca A. Clark...[et al.].
p. cm.
Includes bibliographical references and index.
ISBN-13: 978-0-8018-9111-3 (hardcover : alk. paper)
ISBN-10: 0-8018-9111-6 (hardcover : alk. paper)
ISBN-13: 978-0-8018-9112-0 (pbk. : alk. paper)
ISBN-10: 0-8018-9112-4 (pbk. : alk. paper)
1. Human reproductive technology—Popular works. 2. Surrogate motherhood.
3. Infertility—Popular works. 4. Adoption. I. Clark, Rebecca A., 1958–
RG133.5.P618 2009
618.1'78—dc22 2008023838
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CONTENTS
Preface: About This Book vii
PART I
What Are the Pathways to Parenthood? 1
1. The Fertility Workup 3
2. Early Fertility Assistance: Hormone Stimulation
and Intrauterine Insemination 9
3. Assisted Reproductive Technology (ART) Using
Your Own Eggs or Sperm 14
4. Using Donor Sperm 23
5. Using Donor Eggs and Embryos 29
6. Using a Surrogate 38
7. Domestic and International Adoptions 48
8. Which Options Are Available to You?
The Requirements for Each Pathway 58
9. Considerations for Nontraditional Families 70
PART II
Balancing the Risks and Benefits for Each Pathway 81
10. Your Influence on Genetics and the Fetal and Infant
Environments 83
11. Pregnancy and Medical Risks for Mother and Child 99
12. Mental Health Risks for the Child 117
13. Emotional Costs: What You Might Experience 126
14. Time Costs: How Long before You Become a Parent? 149
15. Hassle Costs: Travel, Appointments, Forms, and
Documents 160
vi Contents
16. Financial Costs: Which Options Are Affordable? 172
17. Legal Considerations 188
18. Final Thoughts 203
Acknowledgments 205
Appendixes 207
A.Summary of Your Influence on Genetic
Background and Fetal and Infant Environments 209
B.Environmental Influence, by Child’s Age and
Type of Adoption 210
C.Summary of Pregnancy and Medical Risks 211
D.Summary of Mental Health Risks 212
E.Summary of Emotional Risks 213
F.Summary of Time from Start of Process to
Conception (Fertility Assistance) or Becoming
a Parent (Adoption) 215
G.Summary of Hassles 216
H.Summary of Financial Costs 217
I.Summary of Legal Considerations 218
Glossary 219
Selected References 225
Index 233
PREFACE
About This Book
Raising a child is one of the most rewarding things a person can
do, and most people reach a point in their lives when they decide,
consciously or not, that they want to be a parent. For a very large
number of women and men, though, becoming a parent is not as
easy as tossing away the birth control and welcoming a baby into
the world nine months later. In fact, every year, hundreds of thou-
sands of American couples are unable to conceive and they seek
fertility advice. Many other individuals have limited options for
achieving parenthood because they are single or older or in a same-
sex relationship. Other people have a medical condition or an in-
heritable disease that restricts how they become parents.
Fertility assistance, surrogacy, and adoption help people over-
come these hurdles and become parents. Within each of these
pathways to parenthood are further categories: minimally inva-
sive fertility assistance methods and more invasive assisted repro -
duction techniques; traditional surrogacy and gestational surr o-
gacy; and public, private, and independent domestic adoptions and
international adoptions. Deciding which pathway to follow can
be mind-boggling, to say the least. Factors such as a woman’s age,
an individual’s genetic history, or a couple’s living situation can all
play a part in the decision.
We are five professionals—two physicians, a psychologist,
an epidemiologist, and a lawyer—who decided to compile our
professional experience and write a book that provides the basic
information that people need to know about each option for
achieving parenthood so that they can decide which pathway will
work best for them. Some of us are also parents who have strug-
gled in our own ways to achieve parenthood. During the process
we considered the pros and cons of our various options by scour-
ing the available literature and asking our friends for advice. We
found the search for data to be challenging, since there wasn’t one
viii Preface
source that compared critical information about each pathway. The
“conception” of this book resulted from the frustration we felt. We
have done our best to lay out what you need to know to make an
informed decision about your strategy to become a p arent.
This book gives you an overview of what you can anticipate
from the various pathways to parenthood. Some people may view
the options as steps along a continuum, starting with minimal fer-
tility assistance and proceeding through every intervention shown
in figure P.1 before finally moving to adoption. Although fertil-
ity assistance can be thought of as consisting of various stages with
obvious stopping points, not everyone needs to go through every
step. You may decide to stop at a certain point and pursue adop-
tion. Some people may start at the “other options” category shown
at the bottom of the figure because, for example, a woman has al-
ready gone through menopause or a gay couple is interested in pur-
suing surrogacy. In the first half of the book, we describe what’s
involved in each option for becoming a parent.
We hope that this book will help you decide on a strategy be-
fore you embark on any pathway to parenthood. We suggest that
you set goals for when to stop pursuing one option and switch to
another; doing so will make it easier to accept that you aren’t hav-
ing success on that pathway and you need to move to another. This
book can help you to outline a plan that you can afford financially
and emotionally and that poses risks you feel comfortable with.
We want you to weigh the pros and cons of the options available
to you. The primary “pro” for all options is becoming a parent.
The main differences between pathways are the “cons” in getting
there, such as medical and emotional risks and time, hassle, and
financial costs. In the second half of the book, we concentrate pre-
dominantly on these cons, although we also note positive aspects
that are worth considering. We want you to be well informed about
the risks but not discouraged by them.
We review fertility assistance methods (including donor sperm,
eggs, and embryos), surrogacy, and adoption (domestic and inter-
national) as possible pathways to parenthood. In part I, the first
seven chapters describe what to expect with each option.Two
Basic Workup
pro bFleemm ailed entifie d Normal problem Midaelnetified
Address Address
Female Male
Problem Problem
Remain Remain (sperm
infertile Early Interventions infertile donor
(including hormone may be
stimulation, recommended)
intrauterine
insemination)
Remain
infertile
Assisted Reproductive
Technology
Remain
infertile
Other options, depending
on your situation,
including donor eggs, donor
embryos, or surrogacy
Figure P.1.Fertility assistance options.
additional chapters discuss the requirements for each option and
considerations for nontraditional families. The chapters in part II
compare the options and identify potential risks and costs (med-
ical, mental health, emotional, time, “hassle,” and financial) and
legal considerations for each option. At the end of each chapter,
we include a personal story—some of these are our stories, some
are stories of our patients and acquaintances. Contributors were
asked to share their experiences or one aspect of their experience
that they would want others to know about. Both positive and neg-
Description:Planning to become a parent is a profound experience, at times agonizing, hopeful, stressful, and joyous. Not everyone is able to become pregnant, however. When the journey to parenthood proves challenging, Planning Parenthood will guide prospective parents through the complicated mazes of assisted
